Compassion Fatigue: When You Care So Much It Hurts YOU

Working in the healthcare industry comes with its challenges, especially when one works with the terminally ill.

Editor’s note: This article is written by Curtis Freed, a GARBC-endorsed chaplain. Because it originally appeared in a non-religious publication, the verbiage is not explicitly Christian or ministerial. We have reposted it here because it contains helpful advice, based on sound, Biblical principles, for ministering to people.

BY CURTIS FREED, MA, BCC, CHAPLAIN AT HARBOR HOSPICE

Working in the healthcare industry comes with its challenges, especially when one works with the terminally ill.

As a hospice chaplain, it is what I do on a daily basis. For physicians, nurses, social workers, nurse aides, chaplains and those who have to take care of a loved one, each day comes with its own unique set of circumstances. There are times when the caregiver can also feel the strain of having to meet the physical, emotional and spiritual needs of the people or person under their care. This continuous strain, known as “compassion fatigue,” can take a toll and even lead to burn out.

I first heard the term Compassion Fatigue a few years ago at a chaplain’s conference I attended. I was intrigued by what I heard and decided to examine it more in depth. The root source of Compassion Fatigue comes out of empathy, and is defined as “the natural consequence of stress resulting from caring for and helping traumatized or suffering people” (Dennis Portnoy, M.F.T., Burnout and Compassion Fatigue – Watch for the Signs).

So what is Compassion Fatigue (C.F.)? Whom does it affect? What are the signs and symptoms of Compassion Fatigue? There have many studies, articles, and even books written on the subject. Basically, C.F. affects anyone who is involved with helping and supporting others. In healthcare, this includes nurses, nurse aides, social workers, clergy and, yes, even physicians. It can also impact counselors, ministers, teachers and many others who are working with people in crisis or needing support. C.F. also affects the son or daughter (or other family members) who is taking care of a chronically ill parent, or the caregiver who stays with the dementia patient who can no longer take care of themselves, or the person who takes care of a child or children in need of constant care.

C.F., at its very core, results from a continuous and steady exposure to those who are suffering, hurting, or even dying. Those who are very compassionate are particularly vulnerable to C.F. because compassion and empathy are what drives many to help the suffering and those who are hurting.

We Are Not Superheroes! When it comes to C.F., no one is exempt! If you are taking care of someone else on a consistent basis then there is a very good chance you will have C.F. We have to remember that we are not superheroes!

When I think about trying to be a “superhero,” I am reminded of a scene in one of my favorite T.V. shows, M*A*S*H. For those of you who may not be familiar with M*A*S*H, the show takes place at an army hospital in Korea in the 1950’s during the Korean War. “Hawkeye” Pierce is a doctor and the main character. In season 1, episode 17 (“Sometimes You Hear the Bullet”), a friend of Hawkeye comes to visit him in the camp. He leaves and then comes back later but this time as a patient because he had been wounded in a battle. The friend later dies.

Hawkeye is devastated and does not know what to do with his grief. He is angry with himself because as a doctor, he felt he could have done more to save his best friend. He breaks down as he tries to talk about it with his commanding office, Colonel Blake. Hawkeye tells Colonel Blake, “Thousands of soldiers came through here and died, why didn’t I cry over any of them?” Blake responds: “I don’t know. Look, all I know is what they taught me in Command School. There are two rules when it comes to war. Rule #1 is young men die [in war]. Rule #2 is doctors can’t change Rule 1!”

I believe the point Colonel Blake is making is that we can’t always be superheroes and solve every problem nor should we try. We are not superheroes who can take care of every one. We need to remind ourselves that we it comes to caregiving, we have our limits too.

Signs and Symptoms. Compassion Fatigue basically affects five areas of our lives including the Cognitive, Emotional, Behavioral, Spiritual, and Physical. Remember that C.F. is caused by empathy – the natural consequence from caring and helping those who are either traumatized, suffering and/or dying. It often involves preoccupation with an individual or his or her trauma. I would like to address each area.

Cognitive Signs

Lack of Joyfulness: result is a difficulty in concentrating

Apathy: lack of feeling or emotion resulting in indifference, we get to the point where we no longer care, “I just don’t have the energy for it”

Disorientation: resulting in no longer able to focus on the task at hand

Minimization: resulting in minimizing (or trivialize) what the person is experiencing

Preoccupation: resulting where we can’t stop thinking of the person’s condition or trauma

Emotional Signs

Powerlessness: feeling you can’t do enough for the person under your care

Anxiety: resulting in constant worry

Anger, fear: resulting in taking out your attitude in others

Depression

Behavioral Signs

Irritable: result is that we are no longer easy to work with, leading to “snapping” at co-workers, friends, family, & even strangers

Withdrawn: results in isolation from family & friends

Mood swings: resulting in increased anxiety, impulsivity, reactivity

Sleeplessness: resulting in nightmares

Digestive problems: resulting in loss or appetite

Spiritual Signs

Questioning life’s meaning or purpose: resulting in the feeling of no longer able to make a difference in your care for the person or your work in

Pervasive hopelessness: resulting in feeling “trapped” in the suffering you see on a daily basis

Questioning religious beliefs: resulting in loss of faith and skepticism of belief in God or Higher Power

Physical Signs

Sweating: resulting in a “Cold Sweat” in certain situations or certain patients

Rapid heartbeat: resulting in certain situations that are overwhelming

Sense of fatigue: resulting in the constant feeling of being “drained”

Treatment

Compassion Fatigue is not something we should take lightly. Numerous studies have been published in healthcare and medical journals how C.F. affects physicians, nurses, clergy and others who work in healthcare. As I mentioned at the beginning, a person does not have to be in healthcare to be affected by C.F. It also affects those who taking care of a spouse, a parent, a child with a terminal illness, or being a caregiver for a friend, and many others who are supporting the wounded and hurting.

Perhaps you are identifying with several of the signs of Compassion Fatigue listed here. So the next question is what can you do about it?

Number one is Self-Regulation.

Know your limits! No matter how much you want to help others, you must remember that you have limits! There is only so much anyone of us can do. It is okay to ask others for help when you need it, and then accept the help graciously when it comes.

Second, find Interconnected Support.

Find someone to talk to (a co-worker, counselor, family member, or friend). You will find that you are not alone. Most likely, you will find someone who has either taken care of someone or is currently doing so. You can share suggestions and ideas to together as you are this journey with your loved one.

Third, rely on Inspiration when you can.

Inspiration can come in various ways including one’s faith and faith community. It can also come through journaling; a journal is a safe place to go to record one’s feelings and emotions in the moment. It is a place of safety to go when you might not have someone to talk to.

Fourth, it’s okay to Let Go and take some time for yourself when you can.

This can include anything from enjoying personal interests such as shopping or a personal hobby to personal exercise or even a home project.

Remember that when it comes to being a caregiver (either professional or on a personal basis such as taking care of a loved one), there are times when it is okay (and important!) to think about yourself. When you do, you will find that it benefit not only yourself but your loved one as well.

Curtis Freed is a spiritual care counselor at Harbor Hospice in Muskegon, Michigan, and a former chaplain at Fred and Lena Meijer Heart Center in Grand Rapids. This was originally published in Muskegon Magazine and is used with permission.